Disease. That word carries so much weight, and as of this week, it also concerns weight: The American Medical Association decided to officially define obesity, a condition that affects over one third of American adults, as a disease.
The decision went against the recommendations of the AMA’s own Public Health Committee to do the opposite, and it means that obesity will now be joining alcoholism and drug addiction as a "condition" whose elevation to "disease" sparks controversy.
So will calling fat people diseased pave the way to a healthier society? Members of the fat acceptance community — advocates for reducing the stigma of obesity-- say that all depends on what you consider “health” to be in the first place.
“The AMA’s decision makes a body size into a health diagnosis,” says writer and fat-acceptance activist Ragen Chastain. She is upset by the AMA’s decision and thinks that it is an affront to her movement's mission.
“The goal is to create a world where fat people are treated with respect, free from bullying, oppression and stigma,” she says. “I think this will absolutely lead to greater stigma.”
The AMA argues the opposite: It cites the reduction of stigma as part of its reasoning for labeling obesity as a disease.
Some advocates of the AMA’s decision say that labeling obesity as a disease is the wake-up call that doctors need to start treating their fat patients using more serious weight-loss strategies, such as bariatric surgeries.
Some also speculate that obesity's new, serious status will put pressure on insurance companies to start covering fat-fighting procedures and treatment as they would, say, smoking cessation.
Lesley Kinzel, a senior editor of Xo Jane and a longtime Boston-based fat-acceptance ativist, says she recognizes that, from a medical standpoint, it is good to address stigma attached to fat patients.
“They may have a point by asking doctors, 'Hey, instead of looking at your fat patients as people with no willpower, let’s see them as having a disease we can treat.'”
However, she fears that “medicalizng” obesity will lead to overtreatment and the over-allocation of scarce insurance dollars to expensive medical interventions.
She has strong doubts that the AMA decision to define obesity as a disease will do anything but increase the stigmatization of fat people outside the doctor's office.
“Culturally, disease has a stigma,” she says. “To call obese people diseased will not elevate that group in the social stratosphere.”
An article from Time Magazine explains that studies have shown that disease labels can actually help redirect pointing fingers away from moral weakness to more complex webs of causal factors outside of the indvidual’s control. However, it warns that even though the AMA has good intentions, its decision isn’t without its darker implications:
A recent review of studies on conditions like addictions and other psychological problems that can have genetic causes found that such classification generally does reduce the blame heaped on people with the disorders, both by themselves and society. But the labels also increased pessimism about recovery, probably because people assume that as diseases with biological and genetic bases, they are immutable. One study on alcoholism, for example, found that the more people bought into the idea that addiction was a “chronic relapsing disease” over which they were “powerless,” the worse their relapses were. Although the label didn’t increase relapse itself, it made it worse if it did occur — and the majority of people with alcoholism will relapse at least once.
The article also points out that classifiying obesity itself — rather than the chronic condtions that can stem from it — as the disease may miss the mark.
The AMA Council on Science and Public Health, which advised against considering obesity a disease, noted that it is more of a risk factor for other conditions — such as diabetes, heart disease and high blood pressure — than a disease in itself.
In other words, it has the same relationship to disease as heavy drinking does to alcoholism: It’s a risk factor, not a disorder. The committee also noted that there are no standard criteria for drawing a line between healthy and unhealthy weights. After a year of study, it argued:
Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state. Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive.
Kinzel warns that calling a body size a disease confuses the matter, because fatness isn’t necessarily a health concern.
“Being fat has radically different consequences for different people," she said. "Some have dramatic health issues; some have zero because they’re fat. I have trouble saying that this is a uniform disease because it doesn’t affect people in the same way.”
Chastain offers her thoughts on how obesity should be considered:
“I think we need to take weight out of the health discussion altogether. Healthy habits are better determinants of health than body size. We need a system that leads to people actually liking their bodies, and therefore believing they are worthy of care. Any interventon that starts off with the idea that certain people’s bodies are wrong is automatically a poor public health intervention.”
Readers? Thoughts? Reactions? Does calling obesity a disease increase or decrease stigma in your eyes?
This program aired on June 21, 2013. The audio for this program is not available.